FRIENDS for Life: process and effect evaluation of a selective school-based prevention programme for childhood anxiety and depression

The proposed study will be conducted within the framework of the 'Academic Collaborative Centre for Youth Health Care Northern Netherlands' in particular by the Municipal Health Service Amsterdam and the EMGO Institute for Health and Care Research and the department of Public and Occupational Health of the VU University Medical Center. Anxiety disorders and depression are highly prevalent in children and adolescents and affect children’s current and future functioning. Childhood anxiety and depression show considerable persistence into adulthood and are likely to deteriorate when left untreated. Investing in the improvement of children’s mental health is important to prevent the ongoing increase of mental health problems in all age groups. FRIENDS for Life is a cognitive-behavioural programme that teaches children the skills to cope more effectively with feelings of anxiety and depression and builds emotional resilience, problem-solving abilities and self-confidence. The programme is increasingly being used at Dutch schools. FRIENDS for Life has been included in the Dutch database of effective youth interventions as ‘effective in theory’ and the programme has been recommended by the World Health Organization. However, the programme’s effectiveness in the Dutch situation has never been investigated. The fact that FRIENDS for Life has been shown to be effective in international studies does not automatically imply its effectiveness and suitability in the Netherlands. Differences in school systems, cultural norms and values, and characteristics of participating children may result in differences in the effectiveness of prevention programmes between countries. Scientific evidence regarding the effectiveness of prevention programmes like FRIENDS for Life in the Dutch situation is essential to guide the prevention activities of Dutch public health services. The aim of the proposed PhD-project is to evaluate the effectiveness of FRIENDS for Life as selective school-based prevention programme for children aged 8-12 years with early or mild signs of anxiety or depression. Various aspects of the programme’s effectiveness and implementation will be investigated: 1. This controlled trial includes a pre-intervention assessment and three follow-up assessments (directly after, and 6 and 12 months after the end of the programme). The primary outcome measure is symptoms of anxiety and depression. 2. We will investigate whether differences occur in the extent to which specific groups of children (with regard to severity of symptoms at the start of the programme, gender, age, and ethnic group) benefit from FRIENDS for Life. 3. A process evaluation will be conducted to investigate whether the programme has been executed according to protocol (programme integrity) and to evaluate children’s and parents’ opinions about FRIENDS for Life using online focus groups and interviews. Insight into the effectiveness of FRIENDS for Life in reducing children’s symptoms of anxiety or depression and in participants’ opinions about the programme is useful to evaluate the desirability of a broader implementation of the programme in Dutch primary schools. Based on the insights regarding the differential effectiveness of FRIENDS for Life for specific groups of children, the programme can be targeted more specifically to certain groups of children, and adaptations or alternatives can be sought for groups of children for whom the programme may be less effective. These insights will contribute to a more tailored and cost-effective implementation of the prevention programme. Since the Municipal Health Service of Amsterdam is currently implementing FRIENDS for Life in Amsterdam an accompanying effect and process evaluation is highly relevant and of utmost importance.